Reducing the Risk of Fall among Oncology Patients using Failure Modes and Effects Analysis.

OBJECTIVE: This project aimed to mitigate the risk of falls among oncology patients using Failure Modes and Effects Analysis (FMEA) in the outpatient setting.



Methods: The project was conducted within outpatient settings, specifically encompassing outpatient clinics, daycare, radiology and radiotherapy, and rehabilitation at the SQCCCRC. The project employed an observational analytical design to assess the fall risk assessment procedure in outpatient settings. The project integrated a 7-step procedure for conducting an FMEA methodology, including defining the system or process, identifying potential failure mode, evaluating the effects of each failure mode, Assigning severity, likelihood, and detection of occurrence ratings, and identifying and implement corrective actions. In addition, Risk Priority Numbers (RPNs) were used to identify the impact of the interventions in reducing the risk of patient fall assessment and management.



Result: In the patient fall screening process, interventions yielded substantial reductions in RPNs for failure modes like "Wrong assessment" (57% decrease) and "Complex risk assessment scale" (63% decrease), addressing knowledge gaps and simplifying risk assessment. Similarly, the "Missed fall assessment" failure mode saw an impressive 80% reduction in RPN, rectifying unclear processes and knowledge gaps. In the Fall risk precaution measures process, interventions led to noteworthy RPN reductions, such as 80% for "Unclear fall precaution measures-responsibilities" and 57% for "Missed bracelets for high risk," demonstrating successful risk mitigation. Moreover, interventions in the Patient Education process achieved significant RPN reductions (57% and 55%) for "No/improper education" and "Unuse of educational material and resources," enhancing staff education and patient awareness. The total reduction in RPNs was 62% in all failure modes in the fall assessment and management process.



Conclusion: Overall, FMEA is a valuable strategy for reducing fall risks among oncology patients, but its success depends on addressing these limitations and ensuring the thorough execution and maintenance of the identified corrective actions.

Exploring causes of delays in help-seeking behaviours among symptomatic Omani women diagnosed with late-stage breast cancer - A qualitative study.

PURPOSE: Breast cancer (BC) is the most commonly diagnosed cancer in Oman; however, the majority of women are diagnosed at a relatively young age and late stage. Delays in BC diagnosis may be attributable to patient-related barriers to medical help-seeking, such as embarrassment arising from breast examinations or negative perceptions of cancer or a cancer diagnosis. Identifying and addressing patients-related barriers to medical help-seeking may help early BC detection, increase the survival rate, and improve prognosis. This study aimed to explore causes of delays in medical help-seeking behaviours among symptomatic Omani women diagnosed with late-stage BC. METHODS: Purposeful sampling was used to identify Omani women diagnosed with late-stage BC (i.e., stages III or IV) at the two main referral oncology centres in Oman. Semi-structured individual interviews were utilised to collect data regarding the participants' reasons for delaying seeking medical help. The qualitative framework analysis approach was used for data analysis. RESULTS: A total of 17 women participated in the study. The mean age was 41.94 ± 7.87 years (range: 27-56 years). Six reasons for delays in seeking medical help were identified, including: (1) Being in denial of BC symptoms; (2) normalisation of BC symptoms attributed to hormonal changes, dietary changes, or work-induced stress; (3) misinterpretation of BC symptoms attributed to other diseases or expectation of more alarming/obvious BC symptoms; (4) pursuit of alternative medicine remedies; (5) false reassurance or incorrect advice from family members or friends; and (6) practical barriers, such as childcare responsibilities and lack of access to transport. CONCLUSION: Several reasons were identified for delays in seeking medical help for BC symptoms, including cultural and emotional factors and a lack of knowledge of BC symptoms. Increased awareness of BC symptoms and a better understanding of Omani women's beliefs, cultures, and behaviours may help to reduce delays in BC presentation and diagnosis.

Prevalence and Factors Affecting Difficult Intravenous Access in Children in Oman: A Cross-sectional Study.

Objectives: Peripheral intravenous (IV) access is a standard procedure in clinical settings. Nevertheless, previous studies have indicated that difficult peripheral IV access is prevalent in children. This study aimed to determine the prevalence and factors contributing to difficult peripheral IV cannulation in children admitted to a tertiary care hospital in Oman. Methods: This cross-sectional study was conducted from September to December 2015 at Sultan Qaboos University Hospital in Muscat, Oman. Nurses collected data concerning factors contributing to difficult IV access in children. Results: A total of 511 children undergoing cannulation during the study period were included in the analysis. Overall, 23.3% of the children experienced two or more cannulation attempts. The study identified three variables associated with successful cannulation in cases of difficult IV access. Visible veins were 2.72-times (95% CI: 1.58-4.68) more likely to be associated with success (p < 0.001), while palpable veins were 2.22-times (95% CI: 1.29-3.83) more likely to be associated with success (p = 0.004). However, scarring from previous IV access attempts was half (95% CI: 0.31-0.77) as likely to be associated with successful cannulation (p = 0.002). Conclusions: We identified statistically significant variables related to difficult IV cannulation in children, which we used to develop a prediction tool to assess the likelihood of difficult IV access in pediatric patients. Further research is necessary to validate the use of the difficult IV access prediction tool in this population.

Cervical Cancer-related Knowledge and Practice among Omani Women Attending a Family Medicine and Public Health Clinic.

Objectives: This study aimed to assess knowledge, attitudes, and screening practices related to cervical cancer and Papanicolaou (Pap) smear testing among Omani women who were visitors to a family medicine and public health (FMPH) clinic. A secondary aim was to correlate the above with the subjects' sociodemographic characteristics. Methods: This cross-sectional study was carried out from February 2020 to April 2021 at the FMPH Clinic of Sultan Qaboos University Hospital, Muscat. A self-administered questionnaire assessed the participants' sociodemographic characteristics, cervical cancer-related risk factors, and their knowledge, attitudes, and practices related to cervical cancer, cervical cancer screening, and Pap smear testing. Results: The participants were 285 Omani women. The vast majority (256/285; 89.8%) had heard about cervical cancer and 208/285 (73.0%) about Pap smear testing. Only 32/285 (11.2%) and 179/285 (62.8%) demonstrated high levels of knowledge in the respective topics. Cervical cancer knowledge scores were associated with education level (p =0.039), whether the qualification was related to healthcare (p < 0.001), and the nature of employment (p =0.033). Pap smear knowledge scores were also associated with age (p =0.001), education level (p < 0.001), whether the qualification was related to healthcare (p < 0.001), the nature of employment (p =0.001), and number of children (p =0.001). Most women were aware of the availability of Pap smear testing in Oman (206/285; 72.3%) and 114/285 (40.0%) had previously undergone this test. Among those who had never undertaken Pap smear testing (171/285; 60.0%), many were willing to do so in the future (103/171; 60.2%). Conclusions: Our results provide an increased understanding of Omani women's level of perceptions, attitudes, and screening practices related to cervical cancer. These findings will help develop strategies to improve Omani women's knowledge of cervical cancer symptoms and screening facilities and promote optimum utilization of the available screening services. Keywords: Cervical Cancer; Papanicolaou Test; Cancer Screening; Health Knowledge, Attitudes, Practice; Human Papilloma Virus; Oman.

Methicillin-resistant Staphylococcus aureus colonization among healthcare workers in Oman.

INTRODUCTION: Methicillin-Resistant Staphylococcus aureus (MRSA) is a S. aureus strain characterized by resistance to cloxacillin. Healthcare workers (HCWs), are recognized for their heightened risk for MRSA acquisition and possibly for MRSA nosocomial transmission. This cross-sectional study aimed to determine the prevalence and the associated risk factors of MRSA colonization among healthcare workers at Sultan Qaboos University Hospital (SQUH) in Oman. METHODOLOGY: A total of 200 nasal swab samples were collected from the healthcare workers at SQUH during the period October 2nd 2018 to January 7th 2019. All nasal swab samples were examined microbiologically for the presence of MRSA using the standard method and the results were confirmed by detection of the mecA product (PBP2a). Data on associated risk factors for MRSA colonization was collected and analyzed. RESULTS: Forty-one of the 200 screened healthcare workers (20.5%) were found to have nasal carriage of Staphylococcus aureus of which 63.4% were Methicillin Sensitive and 36.6% were Methicillin-Resistant (MRSA). Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from fifteen of the 200 screened healthcare workers giving a prevalence rate of nasal colonization with MRSA of 7.5%. We found no statistical association between healthcare worker MRSA nasal colonization and age, gender, HCWs specialty, hand hygiene practices, skin condition, previous MRSA infection, and previous exposure to antibiotics. CONCLUSIONS: Identification of the prevalence and the associated risk factors of MRSA colonization in healthcare workers mandates continuous surveillance and the implementation of all possible preventive measures to reduce re-occurrences.

Symptom Perceptions and Help-Seeking Behaviours of Omani Patients Diagnosed with Late-Stage Colorectal Cancer: A Qualitative Study.

OBJECTIVE: Colorectal cancer (CRC) is the fourth leading cause of mortality in Oman, with most patients diagnosed at advanced stages. Early diagnosis of CRC improves prognosis and survival rate. The aim of this study was to explore the symptom perceptions and help-seeking behaviours (HSBs) of Omani patients diagnosed with late-stage CRC. METHODS: Semi-structured individual interviews were conducted with 16 patients. RESULTS: Four main themes emerged, including normalisation and ignorance (patients felt healthy, perceived symptoms as not being serious and related to dietary habits, concealed them or prioritised work and family commitments), self-empowerment and self-management (patients were stubborn, employed 'wait and see' approach, used symptomatic or herbal treatments), disclosure and seeking help (patients disclosed symptoms to family members or friends, sought medical help only when symptoms worsened, visited faith healers or travelled abroad for treatment) and healthcare professionals (patients attributed treatment or diagnosis delays to lack of continuity of care, loss of trust in doctors or delays in referral). CONCLUSION: Patients attributed delays in CRC diagnosis to several factors based on their perceptions of symptoms. Most HSBs driven by sociocultural and emotional causes. Increased awareness of CRC symptoms and modifying HSBs can encourage early diagnosis. Prompting patients to disclose CRC-related symptoms may aid referral decisions.

Knowledge of symptoms, time to presentation and barriers to medical help-seeking among Omani women diagnosed with breast cancer: a cross-sectional study.

OBJECTIVE: To identify knowledge of breast cancer (BC) symptoms, time taken to consult a doctor and factors contributing to delays in medical help-seeking. DESIGN: A cross-sectional study of Omani women diagnosed with BC. SETTING: The two main teaching hospitals in Oman: Royal Hospital and Sultan Qaboos University Hospital. PARTICIPANTS: Adult Omani women recently diagnosed with BC. TOOLS: The Breast Module of the Cancer Awareness Measure and the International Cancer Benchmarking Partnership questionnaire were used to collect data. RESULTS: A total of 300 women with BC participated (response rate: 91.0%). The mean age at diagnosis was 43.0±12.50 years and 33.5% were diagnosed at stage III or IV. Although most women (74.4%) recognised breast/armpit lumps to be a symptom of BC, less than half identified other symptoms, including breast/armpit pain (44.0%), changes in the position of the nipple (36.2%), redness (31.7%), fatigue (26.3%), weight loss (23.4%) and loss of appetite (20.8%). While most (91.6%) were aware that BC could be cured if detected early, only 66.4% sought medical help within a month of developing symptoms. Initial responses to symptoms included informing husbands (40.2%) or family members (36.5%). Barriers to seeking medical help included feeling scared (68.9%) and worried about what the doctor might find (62.8%). Highly educated women were more likely to recognise the following as BC symptoms: changes in nipple position (OR: 0.16, 95% CI 0.03 to 0.81), breast pain (OR: 0.10, 95% CI 0.01 to 0.86) and unexplained weight loss (OR: 0.18, 95% CI 0.04 to 0.88) (all p<0.05). CONCLUSIONS: Although many Omani women with BC were aware of the importance of early diagnosis, most demonstrated inadequate knowledge of symptoms, did not prioritise seeking medical help and reported emotional barriers to help-seeking. More educational measures are needed to improve symptom recognition and address help-seeking barriers to minimise delays in diagnosis.

Effect of triage nurse-led application of the Ottawa Ankle Rules on number of radiographic tests and length of stay in selected emergency departments in Oman.

AIM: Ankle injuries are commonly seen in the emergency department (ED) and contribute to overcrowding. In Oman, injuries are a leading cause of years of life lost, disability-adjusted life years, and pose a burden to the healthcare system. This study aimed to evaluate the effectiveness of ED triage nurse-led application of the Ottawa Ankle Rules (OARs) toward improving the healthcare outcomes of ankle injury patients. METHODS: A quasi-experimental design was used to collect data (demographic characteristics, waiting time, length of stay, and number of radiographic tests) from 96 patients. The intervention group (n = 46) received ED triage nurse-led assessment and initiation of radiographic tests based on the OARs. The control group (n = 50) received usual care. RESULTS: The participants' mean age was 26.4 ± 7.90 years. The main causes of ankle injuries were football (36%), falls (31%) and twisting while walking (24%). There was a significant difference in number of ankle X-rays (t = 6.19; p < .001); length of stay (U = 549; p < .001); and waiting time (U = 167; p < .001) between the control and intervention group. The intervention reduced the mean waiting time and length of stay by 25.09 and 41.01 min, respectively. CONCLUSION: Application of the OARs by the ED triage nurse can decrease the number of unnecessary radiographic tests, waiting time and length of stay in the ED. Nurses' utilization of evidence-based clinical decision-making tools can improve ED care outcomes of common acute conditions such as ankle injuries.

Healthy work environments are critical for nurse job satisfaction: implications for Oman.

AIMS: To (1) examine the level and variability of nurse work environment and job satisfaction and (2) explore how nurse job satisfaction in tertiary hospitals in Oman is influenced by the nurses' characteristics and work environment. BACKGROUND: In Oman and the Middle East, a scarcity of research addressing nurse work environment and job satisfaction exists. Such evidence is necessary for policymaking to positively impact nurse job outcomes, and therefore, quality of care. METHODS: We used a cross-sectional descriptive design employing a sample of 454 local and expatriate nurses who responded to a self-administered questionnaire. RESULTS: The work environment was favourable, and it positively correlated with job satisfaction. Nationality, education, hospital type, staffing, resources and participation in hospital affairs were significant predictors of nurse job satisfaction. The greatest amount of variation in nurse job satisfaction was explained by the work environment. CONCLUSION: The influence of work environment on nurse job satisfaction is greater than nurse characteristics and hospital and unit types. Enhancing nurse participation in hospital affairs and providing adequate staffing and resources are central means of establishing healthy work environments, which is an auspicious, cost-effective strategy for satisfying, and therefore, retaining nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To enhance nurse work environment and job satisfaction in Oman and the Middle East, nurse and health leaders need to consider developing work and professional regulations and adopting policies to promote staffing, resources, wages, and benefits for nurses and encourage their promotion and career advancement; and foster nurse participation in hospital affairs.

Psychometric Properties of an Arabic Version of the Patient Satisfaction With Nursing Care Quality Questionnaire.

BACKGROUND: Quality measurements are crucial to healthcare quality improvement, and patient satisfaction with nursing care is widely adopted as a key outcome indicator of the overall quality of healthcare. There is a lack of instruments to measure patient satisfaction with nursing care in an Arabic context. PURPOSE: The purpose of this study was to develop and validate an Arabic version of the Patient Satisfaction with Nursing Care Quality Questionnaire and to explore patient satisfaction with nursing care across hospital units. METHODS: This was a cross-sectional, methodological research study. A forward-backward translation process and face and content validation using a panel of experts and a pilot test were used to produce an Arabic version of the Patient Satisfaction with Nursing Care Quality Questionnaire. A convenience sampling technique was employed to recruit 292 adult patients who were hospitalized for more than 48 hours. Data were collected over the first quarter of 2016 using a secure electronic survey method. RESULTS: The item-level content validity index ranged from .83 to 1, and the scale-level content validity index was .94. Evidence of construct validity was obtained. Exploratory factor analysis revealed a two-factor model that explained 69.3% of the total variance. Confirmatory factor analysis showed that the two-factor model fits the observed data. Internal consistency was satisfactory and similar across different hospital units. Cronbach's alpha estimates for Factors 1 and 2 were .83 and .96, respectively, with an overall Cronbach's alpha estimate of .96. Level of patient satisfaction with nursing care was quite high (mean = 4.30/5, SD = 0.74). CONCLUSIONS: This study provides a 17-item, Likert-scaled, self-reporting instrument, which is psychometrically sound for its content, comprehension, readability, and practicality, to measure patient satisfaction with nursing care quality in an Arabic context.

Connecting Communities: The Development of an International Partnership.

Addressing health inequities and the social determinants of health for all people of the world is a primary goal of the World Health Organization. This article describes how a "Connecting Communities educational program" enabled nurse leaders from academic institutions from different sides of the globe to develop a reciprocal relationship of mutual interest around the topics of the nursing role in population health and care delivery. Grant funding resulted in the sharing of knowledge, expertise, and experiences directed toward encouraging the development of nurses as global citizens, with a broader view on what influences health and well-being. This initiative demonstrates how nurses can contribute to the improvement of world health and address the social determinants of health while practicing locally but thinking and contributing globally.

The experiences of newly graduated nurses during their first year of practice in the Sultanate of Oman - A case study.

BACKGROUND: Studies have demonstrated that the transition experience of new graduate nurses is complex and frequently negative, leading to dissatisfaction with nursing and increased attrition. Existing studies of new graduate nurses' transition experiences tend to be concerned with the experiences of new graduate nurses in the West. To date, no study has been conducted examining the transition experience in any Middle Eastern country where the cultural context surrounding nursing education and practice is different. AIM: To explore the experiences of new graduate nurses during their transition period in the Sultanate of Oman. METHOD: A qualitative case study utilising an embedded single case design was conducted to investigate the transition experience of new nursing graduates from one university in the Sultanate of Oman. Data were collected from the perspective of new graduate nurses and also from the perspective of other key informants who are key organisational actors such as clinical instructors, managers and preceptors. As is characteristic of case study design, this study employed triangulated methods including individual and focus group interviews, observation and documentary analysis. Data collected were thematically analysed using Microsoft Access. RESULTS: This study showed that nursing is not an attractive choice for Omani students to study and pursue as a future career. During the transition period, new graduate nurses experienced reality shock resulting mainly from a theory-practice gap. They found themselves with limited practical experience but a high level of theoretical knowledge that was difficult to utilise in practice. They experienced many competing priorities in their working environment which resulted in task-orientation and compromised patient care. Many new graduate nurses resented their involvement in basic nursing care, which they believed should not be part of their role as degree nurses. CONCLUSION: Omani new graduate nurses' transition experiences are complex and highly affected by the working conditions and the status of nursing in Oman. Basic nursing care was believed by new graduate nurses to negatively affect the status of nursing.